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Tell Us About You...

Please provide your (or your patient's) information, and I will be happy to discuss treatment options with you. Also, please fill out the International Prostate Symptom Score sheet ("IPSS) below.

Thank you!

I UNDERSTAND THAT IF I SUBMIT THE INFORMATION BELOW, I AM DOING SO VOLUNTARILY AND THAT IT IS NOT ENCRYPTED. *

I AGREE.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Do you have visible blood in your urine? *

Date of Birth *

Do you use a catheter to drain your urine? *

Who is your urologist? *

What type of insurance do you have? *

What is the name of your insurance plan? *

International Prostate Symptom Score ("IPSS")

1. Incomplete Emptying: How often have had the sensation of not emptying your bladder? *

2. Frequency: How often have you had to urinate less than every 2 hours? *

3. Intermittency: How often have you found you stopped and started again several times when you urinated? *

4. Urgency: How often have you found it difficult to postpone urination? *

5. Weak Stream: How often have you had a weak urinary stream? *

6. Straining: How often have you had to strain to start urination? *

7. Nocturia: How many times do you typically get up at night to urinate? *

8. Quality of Life: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? *

Comments? *

Submit

For More Information...

TELEPHONE NUMBERS:

Office: 781-744-8154
Fax: 781-744-2521

EMAIL ADDRESS:

Raj.Ayyagari@Lahey.org

CLINIC ADDRESS:

41 Mall Road
Burlington, MA 01805

About Me...

I graduated with a B.A. degree in Behavioral Biology from Swarthmore College in 1996. After completing two-and-a-half years of Peace Corps service in the Andes mountains and Amazon rain forests of Ecuador, I went to Yale School of Medicine, where I graduated with an M.D. degree in 2004. I completed the first two years of Urology residency at the University of Washington, followed by residency in Diagnostic Radiology and fellowship in Vascular and Interventional Radiology at Brigham and Women's Hospital/ Harvard Medical School in Boston, MA. After finishing my training in 2011, I went back to Yale, where I was on faculty as an Associate Professor of Interventional Radiology and Urology. In August 2022 I joined the Interventional Radiology staff at the Lahey Clinic outside of Boston.

IPSS Form
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File Type:	pdf

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